TNN: Foot Pain

Almost by accident, my recent web surfing led me to an article that is perfect for my “That’s Not Normal!” thread. I recently attended the Austin February Twitter Happy Hour. I was perusing the list of attendees, looking in particular at other writers and their websites, and I came across this article, “Hitting A Nerve”. The author had experienced a lifetime of foot pain which became particularly severe when her career led to jobs that required standing all day. Only when she was thirty did she discover she had a congenital defect in her feet, one normally detected at birth. Had the author known about it, she might have made many different life choices.

Foot pains like those described by the author of that article are not normal, not part of most human being’s experience. In fact, I’ll go out on a limb here and say any recurring severe or excruciating pain without an obvious cause is not normal and merits investigation until the cause is found.

TNN: Double Vision is Not Normal!

Our second article in the “That’s Not Normal!” series is a perfect example of the phenomenon this series addresses, where someone with a disability doesn’t realize it because he/she always had it and thinks his/her experience is “normal”, what everyone experiences.

All her life, B.D. thought episodes of double vision were normal. If she looked at an object steadily for 3-5 seconds, it would split into two images, regardless of how far or near the object was. The double image would generally go away if she blinked or otherwise diverted her eyes from the object, but it would recur if she looked steadily at it again. She knew her vision was splitting, but it was so common for her that she barely noticed, ignoring that she was seeing two images. This was how her vision had always worked; she thought everyone experienced that.

B.D. did recall having problems with driving on a few occasions. Street lights would sometimes appear to move. She recalled one particular incident where down the road from her car was a stoplight, then a flagpole beside the road, then a building beside the road, but instead of the order stoplight, flag, building, she saw them in the order flag, stoplight, building. She nearly ran the light. At the time, she thought this was somehow related to her dyslexia, which she had been diagnosed with in her early twenties.

This vision problem was missed by all school eye tests and by several optometrists over many years. When she was thirty, she went to a new optometrist, one who had worked extensively with military pilots in the past. He finally performed tests that diagnosed the problem. (B.D.’s doctor never explained whether he noticed something during the routine parts of the examination that led him to do further tests, or whether he simply did a more comprehensive exam in general.)

It turns out B.D. has Convergence Insufficiency (CI), a disorder of eye muscle strength and coordination. (The available figures on the frequency of CI in the population were, ironically, wildly divergent, ranging from 0.3% to 13%.) In this disorder, the muscles controlling eye direction must work unusually hard to coordinate them correctly for binocular vision, causing eyestrain, double vision, transient blurred vision, and/or headaches.

Her optometrist prescribed special eyeglasses that included prisms to compensate for the eyes’ coordination problems. While these prisms actually made her a touch nauseous right at first, she then experienced fewer headaches and less eyestrain and found reading was easier.

She was surprised by the doctor’s diagnosis, but had a bigger “wow” moment soon after when she mentioned this to two of her friends, who then told her they had never once experienced double vision, not even when very drunk or after a blow to the head.

(I was one of those friends, and this prompted a revelation for me as well. I’d just had nasal surgery and realized my experience of nasal breathing had been abnormal all my life. My other friend in that conversation wondered how many people dealt with disabilities they didn’t even realize they had, and thus planted the seeds of this thread, and hopefully eventually a website around this theme.)

B.D. was of course frustrated that this had not been discovered years earlier. About half of her previous diagnosis of dyslexia actually stemmed from this vision problem! B.D. does in fact have true dyslexia as well, experiencing the classic “letter swapping within a word” problem, but having lines of text or words split into two was hardly helpful in coping with that!

Unfortunately, Convergence Insufficiency can require more complex treatment than eyeglasses. It turns out CI has different aspects; the alignment can be off vertically or horizontally. Most people with CI have some degree of both. While both can be corrected by appropriate prisms in the eyeglasses, the horizontal muscles are more elastic and will often adapt and “soak up the prism”, requiring an increasingly stronger prism over time to correct. The vertical muscles are more static and don’t adapt this way. Thus prisms are the standard treatment for vertical issues, but vision therapy, special exercises that strengthen the eye muscles, is often needed for horizontal issues.

B.D. started with just eyeglass prisms, but she was directed to vision therapy when the horizontal muscle control was indeed seen to be worsening. Vision therapy was not easy for her, and with it her eyestrain got worse before it got better, but she no longer regularly experiences double vision.

Double vision is neither necessary nor sufficient for diagnosis of Convergence Insufficiency. Double vision can be caused by many problems other than CI, and a person can have CI without experiencing double vision. Our purpose here is not to diagnose the cause of anyone’s double vision. The diagnosis and treatment of that should be done by an optometrist or ophthalmologist. Our purpose is to tell you that frequent double vision is not normal. If it happens to you often, you should see an eye doctor as soon as possible.

It may sound a bit incredible that someone could experience double vision regularly and not realize how unusual that was. Certainly someone who had had normal binocular vision would realize something was wrong if he/she then began seeing double regularly. But anyone experiencing it their entire life will naturally assume that their experience is universal. This is no different from people with normal binocular vision assuming that their experience is universal. In the latter case it nearly is, so they are of course much closer to being correct, but their assumption means that no non-specialist thinks to ask any questions that could challenge this view. Thus the people with frequent double vision never hear anything that contradicts their assumptions; they have little chance to learn that that isn’t normal.

That brings up a second possible benefit of this series. In addition to letting people with these hidden conditions learn that they have them, it could also lead people without them to learn what can happen and what questions might bring these conditions to light in their family and friends. Before hearing B.D.’s story, I doubt it would ever have occurred to me to ask a child how often they see double. Now, if I ever have kids, I’ll be sure to ask them that when they are growing up.

That's Not Normal!

People naturally define “normal” by their own experiences. What happens in their life, what their body does: these create their perception of normality. But I’ve recently talked with several people who had discovered that they had a physical debility they were previously unaware of. They had coped with it all their lives, so it was what they thought was normal. They thought everyone had to deal with it. Learning that it wasn’t normal, and that (in most cases) it was treatable, was life transforming.

My own experiences with something very simple, breathing through my nose, provide a perfect example of what I mean. I remember when I was on the high school swim team, several coaches told me to breathe in through my nose, not my mouth, while swimming. My stroke was distorted by turning my face too far, which I did to get my entire mouth clear of the water so I could get a good breath. I found their suggestion rather odd though, as it seemed impossible. I tried breathing through my nose, but I couldn’t get enough air to breathe that way while working so strenuously, so I quickly resumed my old breathing style.

Later, when I was in a university marching band (a band with an athletically demanding high-step marching style), people repeated this advice, especially after one incident where I came close to fainting during practice after a cold induced asthma attack. (Breathing through the nose warms and humidifies the air, reducing the risks of such an attack.) But I again dismissed this as silly, even specious: I thought no one could possibly get enough air through just their nose to breathe during such exertion.

Fifteen years later, when seeing an Ear, Nose, and Throat doctor about an unrelated ear issue, the doctor discovered I had enlarged turbinates, which were almost certainly congenital. The air flow through my nose was less than a third of what it should have been. What I thought was normal nose breathing was seriously handicapped.

So I had turbinate reduction surgery. It was a straight-forward procedure, which I had mostly recovered from in a week or so. (I had surprisingly little pain, which I’m told is unusual for nasal surgery.) My first attempt to work out about three weeks later was amazing. I could get enough air through my nose to breathe while exercising at high intensity. That was normal, not my previous experience throughout my life.

When I walked into the fresh prepared food section of Whole Foods Market’s headquarters store for the first time after the surgery, I was overwhelmed. It was heavenly. I was actually light-headed from the intensity of wonderful smells now entering my nose more freely. My body adjusted, so it’s not so overpowering now, but my sense of smell remains stronger overall. I’ve benefited from this surgery in many other ways as well.

Imagine if I had known sooner that my limitations with nose breathing weren’t normal, and if I had had the surgery early in high school. I would’ve been a better swimmer, since my stroke wouldn’t have been distorted by my mouth breathing. I would’ve been a better marching band member, because I certainly could have played better if I didn’t have to take the horn off my lips regularly to get a full breath. And I might have had a more positive view of exercising in general, with all its health benefits.

When I talked about this with friends, I began discovering others with similar stories. B.D. had frequent episodes of double vision, but she didn’t realize that they were very rare for most people. L.K., a woman with lifelong bladder issues, had always experienced pain when she needed to urinate, and thought that was true for everyone; she thought that pain was simply the body’s normal signal for the need to urinate. All these stories had a theme: they had thought their physical experience was universal, not realizing for a long time that it was in fact evidence of an abnormality, much less that it might be treatable. I began to wonder how many other people might unnecessarily endure conditions because they didn’t realize things could be different.

So I am going to establish a recurring feature here, tentatively titled “That’s Not Normal!”. I will post the stories I’ve been given, but I definitely need more. I am looking for stories like these: things you thought were normal or common but turned out not to be, and discovering that improved your health or your life — either through the knowledge itself or through actions you could take with that knowledge. My emphasis at first will definitely be on physical/health issues or very clear-cut psychological issues, but I will take any story you think fits this general mold. (I may even eventually expand beyond human health: Is it normal for my pet to do this? Is it normal for my appliance to do that?)

(Of course the terms ‘normal’ and ‘common’ are imprecise, and even emotionally loaded at times, so we could quickly get into the murky territory of asking what is normal or common, or debating whether something unusual is really a disability to be treated. I may let discussions go there someday, but to start I am going to stick with certain, obvious examples.)

I’m asking my readers who’ve had such an experience to share their story by sending it to me at I promise to hold submitters’ identities in strict confidence (standard disclaimer: unless I am legally or ethically compelled to reveal them). I will strip all identifying information from the story, referring to you using only random initials, then edit and post the stories as appropriate. If I get enough stories and feedback, I will spin this off to its own website. (I think a discussion board would be a useful adjunct to such a site, and I can’t add one here easily.) My hope is that such a site will enlighten others with the same conditions, leading them to get helpful treatment far sooner than they would have otherwise.

[Addendum, January 8th, 2010, 2:45 pm: Also fitting into this mold would be stories where someone realized their condition wasn’t normal, but didn’t understand the magnitude of the difference, or didn’t realize that their condition could be treated.]

[Addendum, January 9th, 2010, 10:00 am: If you think you have an appropriate story but lack time to write it up or find the prospect intimidating, you can contact me, and I will interview you and write the story based on that.]